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Toronto General Hospital program uses new methods to prevent pain killer addictions after surgery

Dr. Hance Clarke, medical director of the pain research unit at Toronto General Hospital, with recent patient Sarah Slater. Clarke believes doctors can do more to prevent patients from developing chronic and debilitating pain after surgery. (Steve Russell / Toronto Star)

Sarah Slater (right) says she wishes she had access to a transitional pain service after undergoing abdominal surgery in 2013. Toronto General Hospital is launching a first-of-its-kind pain program that uses both traditional and alternate therapies to help people deal with chronic pain after surgery. (Steve Russell / Toronto Star)

For most patients, the crippling pain that follows a major surgery fades within weeks as bone and tissue heals.

But for some surgical patients, that pain persists long after scars disappear and never goes away.

Dr. Hance Clarke, medical director of the pain research unit at Toronto General Hospital, believes doctors can do more to prevent patients from developing chronic and debilitating pain after surgery.

He heads a new program — one he says is a world-first — that helps patients manage severe post-surgical pain using a range of traditional and alternate therapies, including acupuncture, exercise, psychological techniques and non-opioid pain medications.

The program is unique in that it provides follow-up care for surgical patients after they are discharged from hospital.

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“We do a good job of dealing with pain in hospital, but those regiments don’t continue beyond the hospital stay,” says Clarke, director of the new transitional pain service at Toronto General Hospital, a part of University Health Network.

Patients who have uncontrolled pain after surgery can sometimes wait up to 18 months to see a pain specialist, he says. During that wait, there is a risk that some patients will get addicted to prescription pain killers.

“After major surgery, 50 per cent of patients get sent home with a prescription for an opioid drug, and a percentage of those patients continue on those drugs long-term,” Clarke says. “And one of the reasons they stay on the drugs is because persistent pain from an operation gets in the way of life.”

The goal of Toronto General’s transitional pain service is to catch patients before their acute surgical pain turns chronic, becoming its own hard-to-treat disease.

Clarke says about 30 per cent of surgical patients are at risk of developing chronic pain, a shift that typically happens about three months after an operation.

“We need to treat people before we miss that window,” he says, noting the one-year pilot program, which launched in June, identifies patients at high-risk of developing chronic pain prior to their surgery.

Sarah Slater says she wished she had access to the transitional pain service after undergoing abdominal surgery in March 2013.

It was her fourth operation to remove scar tissue from her small intestine, a complication of Crohn’s disease, but the first time that the pain following her surgery did not disappear.

Slater, who works as an insurance billing assistant and as an archery coach, says she sought help for the pain that, on her worst days, is a relentless stabbing in her right side that prevents her from holding an archery bow or from standing while travelling on the subway.

“Every time I mentioned I had chronic pain, doctors would try to find the source rather than handle the long-term effects of the pain,” says Slater, now 35, and who wants to avoid opioid pain killers as much as possible.

“I always ended up leaving hospital with more narcotics.”

Slater, now enrolled in the transitional pain service, says the interdisciplinary team has helped her immensely, particularly in developing psychological strategies to manage her pain.

“Knowing that someone is looking at my pain in the long-term has decreased my stress immensely.”

Clinical psychologist Dr. Aliza Weinrib uses a psychological technique called mindfulness — what she calls “the art of paying attention to the sensation of the present moment” — to help patients manage their pain.

Coping mechanisms, along with other psychological supports, can help prevent acute pain from becoming entrenched, Weinrib says, noting research has shown that there is “a huge psychological component to pain.”

Chronic pain also impacts people’s moods, she says, another reason why it’s important to treat people at-risk for constant pain soon after surgery.

“Pain makes people more vulnerable to depression. And once you have depression, that can amplify the pain.

“I teach people to work on small steps to tackle their pain. It’s not the size of the step, but the direction that is taking them that is important.”

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